By George W. Chapman
It’s been said here several times that the U.S. gets the worst bang for the buck when it comes to the cost of care versus results.
With the cost per capita of more than $14,000 a year, we rank around 40th in overall mortality. And nothing says how poorly we perform more than Black infant mortality.
Per 100,000 births, it is three times higher than the mortality rates for Whites (14), Hispanics (12) and Asians (11). The infant mortality rate for Black infants is astounding 50 per 100,000.
The mortality report leaked out just after the official “temporary pause” on external federal health agency communications. (Pausing all federal health communication is a totally different problem. In the future, will we ever know what’s wrong?) Studies have shown that more Black docs lead to better outcomes. Unfortunately, the number of Blacks attending medical school has dropped off sharply the past several years. Attempts to curtail health insurance for at-risk populations will only exacerbate the mortality problem.
Deferred Resignation Offer to VA Nurses
If any group has earned the right to receive healthcare, it is our veterans. Yet the White House is offering VA nurses, the government’s largest group of employees, deferred resignations. This is being done before any valid analysis and done when half of our VA hospitals are operating under severe staffing shortages. The nurse union is encouraging their members not to take the bait. When care eventually deteriorates further due to nurse shortages and the VA is finally allowed to hire more nurses, where do the powers that be think they will come from? The VA cares for more than 9 million veterans.
Physicians Suing the Government
Doctors for America is suing several federal agencies over the removal of several web pages from websites covering a broad range of health-related (scientific and validated) data used daily by providers and researchers. In fairness, the agencies being sued were mandated to take down certain web pages by the new administration. The agencies are: CDC, OPM, FDA and HHS. The lawsuit is brought by the Public Citizens Litigation Group. One can only hope that science, not politics, determines what information is available to us all let alone our providers and researchers. Will any of these agencies even exist in the future? Scary. A judge has since ordered the pages reinstated.
Fentanyl Deaths
The leading cause of death among 18-45-year-olds remains fentanyl overdoses. In 2023, more than 107,000 of us died from an OD with 70% being from the opioid fentanyl. While measures are being taken to slow down, if not stop altogether fentanyl smuggling into the U.S., a new drug developed by the school of pharmacy at the University of the Pacific can save lives. naloxone is the chemical in Narcan which is used to counter overdoses. Narcan lasts up to two hours when delivered as a nose spray. Researchers at U of P found that the HD-5 molecule when added to naloxone allows Narcan to be delivered via injection versus nose spray. Consequently, the medication lasts in the body for a week preventing overdoses for longer and more often.
Impact of Tariffs
No matter what the final outcome of the tariff war with Canada, it will inevitably increase the cost of medical equipment we import from our friendly neighbors to the north. Medical equipment has typically been exempted from tariffs per the free trade agreement that existed between the US, Mexico and Canada. Guess who signed it? Anyway, unless the medical equipment exemption continues, we can expect higher costs for MRIs, ventilators, wheelchairs, pace-makers, insulin pumps and orthopedic implants. In 2022, Canada imported $5 billion of medical equipment from the US or 38% of their total medical imports. We imported $3 billion from Canada. Clearly, the trade imbalance favored the U.S. Any tariff on Canadian medical equipment will negatively impact both cost and access to both countries.
Reducing Drug Costs
The U.S. could make substantial inroads toward reducing the exorbitant cost of care in the US by hundreds of billions if Congress would simply take the handcuffs off CMS negotiators and let them negotiate the price of all drugs with Big Pharma on behalf of all 335 million citizens. But our purchasing power has been stilted/controlled by the powerful drug lobby which has reluctantly agreed (gun to head) to striking deals per the Inflation Reduction Act (IRA) on 10 drugs for 2026 for our 60 million Medicare recipients. (We actually had to pass a law to allow Medicare the ability to get our consumers the best bang for our bucks.) Instead of taking the 10-drug limit as a win, Big Pharma continues to lobby for the repeal of the Inflation Reduction Act. Will our newly created Department of Government Efficiency dare take on the drug lobby and recommend negotiating all drug costs and not just a few at a time? We’ll see. In the meantime, with the initial 10 prices to take effect in 2026, CMS has indicated the second round of 15 drugs to be negotiated per the IRA. These 15 new prices take effect in 2027. Among them are: Ozempic, Rybelsus, Wegovy and Trelegy. Instead of thwarting physician, hospital and nursing facility reimbursement, CMS should be laser focused on going after the fat in drug prices.
Uninsured Will Increase
To reduce costs, the White House is proposing to cut $2.5 billion from Medicaid by disenrolling 25 million people that qualified for coverage during the pandemic via expanded eligibility. Currently, Medicaid covers more than 70 million people. If the Affordable Care Act is repealed, even more than the 25 million on Medicaid will lose affordable insurance they purchased via the health exchanges. In 2023, our uninsured rate was at an all time low of 8%. If Medicaid is cut and the ACA repealed, the uninsured rate could jump up to 15% or four million per year through 2034. This significant loss of insurance will create more uncompensated care for already struggling clinics, emergency rooms, hospitals and health systems. Making matters worse, patients without insurance tend to postpone or delay care so when they finally seek care they are much sicker. To make up for these losses, providers will be forced to negotiate higher rates with commercial carriers thereby forcing commercial insurance rates up. Is it time we gave serious consideration to a national health plan? We can’t stop a boat from sinking if we only plug some of the holes. We need a new boat.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse.